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New Care Designation Focuses on Patients
By Mary Anne Gates

The primary care medical home (PCMH) option newly created by The Joint Commission complements its long-standing ambulatory care accreditation process for medical facilities.

In conjunction with existing ambulatory care requirements medical facilities must currently achieve to meet accreditation standards, The Joint Commission recently identified five additional operational areas of patient care to earn the PCMH option. The first PCMH designation was awarded to AltaMed, a southern California-based healthcare facility, after a thorough, unannounced, on-site survey in July. The Joint Commission evaluated AltaMed staff for compliance, focusing on the following operational areas:

• patient-centered care;

• comprehensive care;

• coordinated care;

• superb access to care; and

• a systems-based approach to quality and safety.

PCMH Goals Achieved With HIT
“HIT has helped us standardize processes, track patients and their needs, improve security, and look at data trending throughout the organization,” says Martin Serota, MD, chief medical officer for AltaMed. “Not only does this allow us to provide each patient a better standard of care, it allows us to look at our patient population as a whole, monitor data, and help make improvements in preventative care. HIT has made communication easier between AltaMed team members. Going forward, HIT will also provide bidirectional communication with other care providers in the community.”

HIT enables AltaMed, a nonprofit healthcare organization delivering integrated primary care services, senior care programs, and health and human services for the whole family, to do the following:

• maintain continuity of care with a provision for comprehensive and coordinated care;

• document and track care;

• support disease management, including providing patient education;

• support preventive care;

• create reports for internal use and external reporting;

• facilitate electronic exchange of information among providers;

• support performance improvement; and

• use e-prescribing processes.

While The Joint Commission has not ordered specific HIT paradigms at this time in reference to earning a PCMH designation, the intent is to provide the highest-quality, most comprehensive patient care.

“We don’t mandate or define HIT criteria for PCMH accreditation. We did not go as far as mandating EHRs,” says Michael Kulczycki, executive director for the ambulatory care accreditation program at The Joint Commission. “However, the current standards give us building blocks for the future.”

The Joint Commission and AltaMed Collaborate
Working together for the best possible patient outcomes is second nature to The Joint Commission and most healthcare facilities, including AltaMed. And while future PCMH standards may build on existing requirements, for now—even as the ink is still drying on the recently acquired option—AltaMed is already beginning implementation of recommendations made during the course of the survey.

“One of the most interesting parts of The Joint Commission survey process is the collaborative nature of their visits,” says Serota. “One of their recommendations was to add a process improvement standard and a way for our patients to suggest improvements. We have created work plans to add these elements, and our patients will see them in the weeks to come.”

An AltaMed Patient Visit
A typical visit involves meeting the care team and addressing the patient’s immediate needs and concerns in addition to covering other issues the patient may not have considered, including healthy habits, preventive care, nutrition, exercise, and vaccinations. Patients with chronic conditions such as diabetes or heart disease benefit most from the medical home, says Serota.

During a first visit with the organization, patients are connected with a case manager who meets with them, places follow-up calls, and visits on a weekly or monthly basis depending on the nature of the condition. Case managers also schedule referral visits with specialists, order prescriptions, and coordinate transportation, among other tasks. The health education team provides ongoing disease-specific education. Additionally, frailer patients may also receive some in-home services.

What PCMH Status Means to Patients
PCMH-designated facilities provide or assist patient access to a wide range of health services, including the following:

• acute care;

• oral healthcare;

• management of chronic care;

• urgent and emergent care;

• behavioral health needs;

• substance abuse treatment; and

• preventive services that are age- and gender-specific.

Other perks patients enjoy at a PCMH-designated facility include 24/7 patient access to test results, requests for prescription renewals, and clinical advice for urgent health needs. Flexible scheduling and interpreter and translation services are also available. Further, patients are allowed to designate their primary care clinician. Finally, self-management goals are identified, and education is given to help patients better manage their own healthcare results.

— Mary Anne Gates is a medical writer based in the Chicago area.